The procedure whereby the common bile duct is explored following surgery is known as cholangiography whereby a device known as a T-tube is inserted into the common bile duct for the injection of a contrast material which will demonstrate the presence of gallstones. The T-tube is a hollow rubber tube that is shaped as the letter "T". The upper branch of the tee is actually inserted into the common bile duct and the long lower shaft extends out of the abdominal cavity and the patient to allow the surgeon to inject a radiopaque dye that will travel into the common bile duct.
The most troublesome problem in performing completion cholangiography, following exploration of the common bile duct, is the necessity of inserting and meticulously suturing the common bile duct around a T-tube before the injection of contrast material can be performed. Demonstration of retained stones necessitates removal of the secured T-tube and re-exploration of the common bile duct. Since the incidence of missed stones demonstrated by intraoperative cholangiography has been reported at 14 percent, this time consuming and often frustrating technical maneuver may have to be repeated several times before the common bile duct is cleared of stones.
Following completion cholangiography, the T-tube is finally sutured in the common bile duct and the shaft is passed through an incision in the abdominal wall allowing for drainage during the post-operative recovery period. A modified T-tube is known wherein an inflatable balloon is positioned some distance from the upper branch on the body of the main shaft. The balloon is inflated from outside of the patient and inflates just inside the abdominal wall thereby precluding inadvertent removal of the T-drain tube. Such a device was at least once listed in a supply catalogue of American Cystoscope Makers, Inc. but to the best of my knowledge is not presently used or even available.
Despite the number of cholecystectomies performed annually and the attendant problems that have been described, no one has provided a method whereby post-operative cholangiographies can be performed without suturing and removal of a T-tube in the common bile duct with possible repetitions. Similarly, a T-tube or other means that would obviate the suturing procedure has not been employed heretofore.